A head of wheat in the bladder

In December 1871 Dr B. B. Leonard, a general practitioner from West Liberty, Ohio, was summoned to examine ‘J.J.’, a 41-year-old farm worker from a neighbouring village. This is what he subsequently reported to the Cincinnati Lancet and Observer:

On the 3rd of July, Mr. J was binding wheat in the field, and when about half way through his binding station, felt severe pain at the meatus urinarius [the opening of the urethra], and a sensation as of something passing into the urethra. He, however, with more forbearance than prudence, determined not to be overtaken by the machine, and therefore deferred an examination until he arrived at the end of his station; when an inspection revealed the fact that a head of wheat had entered the urethra, and ten or more beards protruded. These he caught, and endeavored to remove the head, but failed to do so, the beards pulling off.

It’s difficult to understand how this could have happened, unless Mr J. preferred to spend harvest time in the nude.

The whole head now passed rapidly into the bladder. Ten days after the accident Dr. Robb was called, and found that no treatment had been instituted, and the patient suffering from acute cistitia [cystitis]. Opiates, saline cathartics, and mucilaginous drinks were ordered, and also injections into the bladder of mucilage, with a sufficient amount of belladonna to quiet pain.

Mucilage is an edible gluey substance produced by plants. It was frequently used at this period as an anti-inflammatory agent.

These were ordered daily, with the hope that the offending intruder night become inverted and thereby escape from the bladder. This treatment was continued for some weeks, during which time an occasional grain of wheat, or beard, or husk, would pass covered with stone. After two months, the nucleus become so completely covered with stone, that it was resolved to resort to the use of the lithotrite.

Lithotrites, to be inserted through the urethra. Ouch.

The operation of lithotrity for bladder stones was an early example of minimally-invasive surgery. It was invented in the 1830s by the French surgeon Jean Civiale. An instrument like a curved pair of forceps, the lithotrite, was inserted into the bladder via the urethra and used to crush the stone into fragments small enough to be passed with the urine.

A part of the stone was crushed by this instrument, and passed, containing five or six grains of wheat, chaff, and other debris. The peculiar location of the stone rendered it impossible to grasp it with the lithotrite, and the doctor, with commendable sagacity, attempted solution, by the injection of a mixture of forty parts water to one part of nitric acid. The next day two drachms of dissolved stone passed from the bladder. The deposit, however, necessarily being repeated as long as the foreign body remained, it was determined to resort to lithotomy.

Bad luck! Lithotomy (cutting into the bladder) was a far more dangerous and traumatic experience.

Having prepared the patient for so formidable an operation, and assisted by Drs. Bobb and Crew, and Sharp and James, I operated by the left lateral operation, and removed the head which had been incarcerated for six months. It is well represented in the following cut:

The offending object

The case is interesting in this: that it demonstrates the possibility of such accidents, and the ability of the bladder to tolerate the presence of so rough a body, even when suddenly introduced. The recovery was unusually rapid, and Mr. J resumed his ordinary labor in less than four weeks.